Individual Workload Research Articles

The interface between health systems and vertical programmes in Francophone Africa: the managers’ perceptions

To explores the interface between vertical programmes (VPs) and general health services (GHS) in sub-Saharan Africa. Using semi-structured interviews, we analysed the perceptions of a selection of experienced mid-level managers of health systems and of VP originating in francophone Africa on the nature and quality of this interface. The respondents acknowledged that VPs lead to both positive and negative effects on the functioning of GHS. The overall result, however, cannot be viewed as a simple summation of the positive effects possibly compensating for the negative ones. Indeed, some of the negative effects have a profound impact on the management and operation of the health care delivery system and may undermine the long-term institutional capacity of the general health systems. The quality and the nature of the interface between VP and GHS strongly vary in time, between settings and programmes. We argue for more systematic monitoring of the interface between VP and GHS, so as to identify and address, in a timely manner, significant disruptive effects and deficiencies in a perspective of systemic capacity building of health systems.

Can Team‐ and Inquiry‐based Methodologies Work in a Field Laboratory?

Can Team‐ and Inquiry‐based Methodologies Work in a Field Laboratory?

Individual estimated sensitivity and workload for manual screening of SurePath gynecologic cytology

Data correlating individual screening sensitivity in gynecologic cytology and workload is limited. We compared the estimated sensitivity of manual screening of SurePath slides with individual workload. Estimated sensitivity determined by rapid prescreening was correlated with total workload in a laboratory performing manual screening of SurePath preparations for a 1 year period. There were 12 CTs with a total daily workload ranging from 8-35 slides. The mean estimated sensitivity for SurePath was 97.0% (range 91-100%). The mean estimated sensitivity for the lowest half workload (8-23 slides/day) was significantly higher than that for the highest half workload (23-35 slides/day) (98.3 versus 95.7%, P ≤ 0.001). The highest workload that achieved 100% estimated sensitivity was 30 slides/day. For manual screening of SurePath slides, individual estimated sensitivity is correlated with workload even at relatively low daily workloads.

A Comparison of Artificial Neural Networks, Logistic Regressions, and Classification Trees for Modeling Mental Workload in Real-Time

The use of eye metrics to predict the state of one's mental workload involves reliable and accurate modeling techniques. This study assessed the workload classification accuracy of three data mining techniques; artificial neural network (ANN), logistic regression, and classification tree. The results showed that the selection of model technique and the interaction between model type and time segmentation have significant effects on the ability to predict an individual's mental workload during a recall task. The ANN and classification tree both performed much better than logistic regression with 1-s incremented data. The classification tree also performed much better with data averaged over the full recall task. In addition, the transparency of the classification tree showed that pupil diameter and divergence are significantly more important predictors than fixation when modeling 1-s incremented data.

Physical fitness in depressive patients and impact of illness course and disability

Background There is a large and increasing body of evidence that physical exercise, such as endurance training, exerts antidepressant effects in psychiatric disorders. However, compliance rates are rather low due to reduced energy and lack of motivation. Another important reason may be low baseline fitness leading to overstrain when participating in a training program. The aim of the study was to evaluate the physical fitness of depressive patients compared to healthy controls by a standardized assessment. Methods 51 hospitalized depressive patients were investigated by a standardized physical fitness assessment on a bicycle ergometer including measurement of maximum workload (pmax), heart rate, lactate concentration, workload at first lactate elevation (pLT), individual anaerobic threshold (IAT) and workload at IAT (pIAT). They were compared to 51 healthy controls matched for age, sex and body mass index. Results p(max), p(LT) and p(IAT) were markedly reduced in depressive patients compared to healthy controls ( p < 0.001). Lactate increase was faster and steeper in depressed patients, albeit differences never reached significant levels. There was a significant negative correlation between the length of disability and poor performance parameters but no significant correlation with other illness variables. Limitations The study was not prospective and no study protocol was applied. Conclusion This study demonstrates a marked reduction of physical fitness in depressive patients which cannot be explained by differences of body mass index or age. When designing therapeutic exercise programs for depressive patients evaluation of baseline training level is recommendable because many patients might overstrain themselves because of strongly reduced baseline fitness.

Burnout in nurses – the relationship between social capital in hospitals and emotional exhaustion

The aim of this study is to examine the relationship between a hospital's social capital, individual decision latitude, workload and emotional exhaustion in nurses, controlling for age, sex, years of professional experience and job tenure. In western countries between 15-45% of nurses working in hospitals suffer from burnout, characterised by emotional exhaustion, depersonalisation and decreased personal performance. The prevention of burnout constitutes a great challenge to those responsible for the health care system, not least because burnout may cause increasing turnover rates in nurses and lead to medical mistakes. Survey. A questionnaire was mailed to 1325 nurses working at four hospitals in east and west Germany in 2002. Nine hundred and fifty nine nurses responded (response rate: 72.4%). Logistic regression identified three significant predictors of emotional exhaustion in nurses: workload (OR: 4.523, CI: 3.230-6.333) was positively associated with emotional exhaustion. Decision latitude (OR: 0.376, CI: 0.254-0.557) and social capital in the hospitals (OR: 0.549, CI: 0.403-0.746) were negatively associated with emotional exhaustion. Emotional exhaustion was not affected by age, sex, years of professional experience and job tenure. Nagelkerke's Pseudo R(2) was 0.225. The findings underline the importance of social capital and organisational development in hospital management. Efforts to create a good working atmosphere with readiness to provide mutual support and the pursuit of joint values in a hospital, the reduction of workload and increased decision latitude may prevent the development of emotional exhaustion in nurses.

All things being equal: observing Australian individual academic workloads

The achievement of greater gender equity within Australian universities is a significant issue for both the quality and the strength of Australian higher education. This paper contributes to our knowledge of academic workloads, observing individual workloads in business faculties. A multiple case study method was employed to observe individual academic workloads. Two regional universities were selected for this research on the basis of their senior staff profiles. Multiple sources of evidence were used to gather teaching and research workload data for all faculty members. Differences in workloads were not always evident between genders. Our results suggest that universities that are over-represented with females in senior academic positions when compared to the national average achieve equity in workload. Universities that are underrepresented with females in senior academic positions do not achieve workload equity with male academics producing more research and coordinating more teaching.

Minimum standards for urodynamic practice in the UK

This paper reports on the recent publication and wide distribution of a joint statement on minimum standards for urodynamic practice in the UK. A multidisciplinary working party were tasked with creating standards for both training and certification in urodynamics, as well as explicit standards for a framework of service delivery. This was done through a process of extensive consultation with relevant professional bodies. The standards suggest a modular structure to urodynamics training, and make recommendations on minimum workload for individuals and departments, the need for multidisciplinary team working and for regular audit. This is the first attempt to standardise urodynamics practice nationally. The document is available on the United Kingdom Continence Society websitewww.ukcs.uk.net.

Assessing team workload under automation based on a subjective performance measure

This study presents a subjective measure approach to assess how automation impacts teamwork. Hart and Staveland (1988) indicated that the subjective measure approach is the conventional most commonly used workload assessment method that represents the criteria against which other measures are evaluated. The subjective experience of an operating crew regarding workload normally involves the influence of many factors in addition to the objective demands imposed by a particular task. Therefore, this study first assumes that team workload is a hypothetical construct that represents the cost incurred by a specific crew to achieve a particular level of team performance. The concept of team workload is developed by applying individual workload concepts, principles, and relations to a team environment. Although teams are increasingly important in the workplace, team workload has seldom been evaluated in literature. Therefore, this study develops a subjective performance measure approach to optimize team workload. An illustrative example demonstrates the effectiveness of the proposed approach. Results of this study significantly contribute to research efforts in the field of workload measurement under automation.

Clinical renal networks: evolving services and expertise around the UK

<h3>Aims</h3> To determine the range of renal services available outside major paediatric nephrology centres, and the clinical expertise operating to deliver this. To understand the functioning of clinical networks. Also, to compare with a similar survey from ten years ago. <h3>Methods</h3> On behalf of the British Association for Paediatric Nephrology, initial information was received from all major paediatric nephrology centres about surrounding hospitals and possible “link” paediatricians. A further questionnaire was then sent to all paediatricians thus identified (n=111). This survey covered aspects of clinical practice and experience, governance, management and job-planning. <h3>Results</h3> Fourteen paediatric nephrology centres in the UK interact with at least 202 other paediatric centres, providing services, help and advice in conjunction with local paediatricians. However, the way this is delivered varies considerably, ranging from actively managed networks, to ad-hoc interaction without planned direct contact. In over 125 local hospitals, there was a stable relationship between a single lead paediatrician and a named paediatric nephrology centre, and in 104 places, regular shared-care nephrology clinics were undertaken. The burden of shared care clinics around the UK amounted to a total of 538 clinics per year. In over 50 other hospitals (mainly smaller centres), there was no significant link. In 65 full replies from local paediatricians with “renal interest/expertise”, level of service and expertise varied widely. Of these, 49 paediatricians took renal referrals from their colleagues and 31 conducted regular nephrology-only clinics alone. Individual renal workload varied between &lt;1 and 5 P.A.s per week, although usually not specifically defined as such in job-plans. The survey highlighted the impact of the follow-up of antenatally-detectable renal tract anomalies, and these services were often delivered independently from other renal provision. Compared to a similar survey from 10 years ago, there has been considerable expansion in local designated renal services. <h3>Conclusion</h3> These data highlight the quantity and range of renal services delivered outside major paediatric nephrology centres in the UK, by paediatric nephrologists, and paediatricians with varying renal expertise, and provide important information for developing networks and appropriate workforce planning.

The introduction of automated dispensing and injection during PET procedures: a step in the optimisation of extremity doses and whole-body doses of nuclear medicine staff

Significant staff exposure is generally expected during PET-and PET/CT applications. Whole-body doses as well as extremity doses are usually higher per procedure compared with SPECT applications. Dispensing individual patient doses and manual injection involves high extremity doses even when heavy weighted syringe shields are used. In some cases the external radiation causes an exposure to the fingertips of more than 500 mSv y(-1), which is the yearly limit. Whole-body doses per procedure are relatively lower compared with extremity doses and are generally spread over the entire procedure (Guillet, B., Quentin, P., Waultier, S., Bourrelly, M., Pisano, P. and Mundler, O. Technologist radiation exposure in routine clinical practice with 18F-FDG PET. J. Nucl. Med. Technol. 33, 175-179 (2005). Optimisation of the individual workload is often used to restrict staff doses, but many PET centres face the need for further optimisation to reduce the staff doses to an acceptable level. During this study the effect of the use of an automated dispensing and injection system for (18)FDG on whole-body doses and extremity doses was evaluated. Detailed dosimetric studies using thermoluminescent and direct ion storage dosimetry were carried out before and after the introduction of this system. The results show that the extremity doses can be reduced by more than 95 % up to a mean level of 10 muSv per handled GBq. At the same time, whole-body doses can be halved during injection of the tracer. This results in a dose reduction of 20 % during the entire procedure of injection, escorting and positioning. In this way, the study shows that with the use of automated dispensing and injection a considerable staff dose reduction can be obtained.

Effects of Physical Effort on Neuroretinal Function in Athletes and Non-Athletes: An Electroretinographic Study

Physical exertion may disturb retinal function. We wondered whether different levels of physical performance could affect the plot of neuroretinal activity after dynamic exercise in healthy subjects. The aim of our study was to estimate the effect of increasing intensity physical exercise on retinal activity in 2 groups: athletes (n=10) and non-athletes (n=10). We analyzed the amplitude and implicit time of b-wave electroretinogram (ERG) responses for a photopic white 30-Hz flicker stimulus. Using a cycloergometer, 3 10-minute effort tests with increasing intensity were performed. Each participant was attributed an individual workload value (W) below his lactate threshold (40% VO2max), at his lactate threshold (65%-75% VO2max), and above his lactate threshold (80% VO2max). Five ERG recordings were taken: before the efforts (first), immediately after the 3 consecutive efforts (second to fourth), and 1 hour after the last effort (fifth). After the first effort, in both groups we observed a statistically significant increase in b-wave amplitude (p<0.05), and in non-athletes a decrease in implicit time of b-wave (p<0.05). After the last effort, we observed a decreased b-wave amplitude in non-athletes, whereas in athletes the amplitude remained at a high level. Physical effort significantly differentiated the plot of b-wave amplitude changes between athletes and non-athletes. These findings suggest that strenuous physical effort may disturb signal transfer in the inner retinal layer in non-athletic subjects. The ERGs may be used as a neurophysiologic indicator in defining the cardiovascular training status of an athlete.

The effect of physical effort on retinal activity in the human eye: rod and cone flicker electroretinogram studies

The aim of our study was to assess the effect of physical exercise with increasing intensity on neuroretinal activity in healthy subjects (n = 30). We analysed the amplitude and implicit time of b-wave electroretinogram (ERG) responses in two experiments: (1) for a scotopic blue 10 Hz flicker stimulus (rod-mediated responses), and (2) for a photopic white 30 Hz flicker stimulus (cone-mediated responses). Using a cycloergometer, three 10-minute effort-tests with increasing intensity were performed. Each participant was assigned individual workload values (W) below the lactate threshold (40% VO(2)max), at the lactate threshold (60-65% VO(2)max) and above the lactate threshold (80% VO(2)max). Five ERG recordings were taken: (1) before, (2-4) immediately after the three subsequent efforts and (5) 1 hour after the completion of the last effort. The right eye was selected for monocular stimulation in both experiments. After the first effort (40% VO(2)max), we observed an increased amplitude (p < 0.001) and decreased implicit time of the b-wave (p < 0.01) in cone-mediated responses, and no significant effects in rod-mediated responses. Despite the increase in effort intensity, the cone b-wave amplitude remained unchanged, whereas the rod b-wave amplitude significantly decreased after the subsequent efforts (p < 0.001). Rod-mediated responses were more susceptible to effort-induced homeostasis disruptions than the cone-mediated responses. The application of ERGs may be used as neurophysiological criteria in defining the cardiovascular status of the physical performance.

A Comparative Study of Objective and Subjective Assessment of Occupational Risk

Measurements of dangerous, harmful and annoying factors in the working environment are used to assess occupational risk. Surveys on workers ‘ subjective perception of risk are used, too. This study aimed to compare subjective assessment of work-related factors with their objective measurements and a national database on occupational risk. Spearman’s correlation analysis, stepwise regression analysis and structural modelling were used to determine the relationship between subjective and objective risk assessment and to acquire knowledge about the role of psychosocial job characteristics as predictors of subjective assessment. Subjective assessment of hazards was related not only to their objective measurements but also to psychosocial job characteristics, workers ‘ individual characteristics and work load. Even though subjective and objective assessments of hazard are strongly related, they are distinct phenomena. Hence, risk assessment should be carried out with both objective and subjective methods.

Benchmarking in radiology: apples and oranges?

There is little formal coordination or understanding between UK radiology departments in terms of standards relating to departmental work output or consultant workload. As a result, there are likely to be significant variations in work patterns, individual consultants' workload and work intensity in different units around the country.

Relationship among workload, health complaints, and depressive state of workers as revealed using a questionnaire survey

Identifying the relationship between workload content and health complaints would likely aid the establishment of preventative health care strategies. The study population consisted of 137 male workers from a pharmaceutical company. The workloads of the target subjects were divided into three groups (A, B, and C+D) according to the scores of a self-administered questionnaire. The results of General Health Questionnaire (GHQ, 12 items version) for assessing health complaints were also analyzed. The percentages of workers who reported feelings of stress in response to overtime work, irregular work, business trips, nighttime work, no rest and/or no nap, mental workload, and physical workload were 22.6%, 15.3%, 2.9%, 8.0%, 13.9%, 58.3%, and 18.2%, respectively. The significant odds ratio of workload predicting health complaints was 6.9 for subjects in group B and 13.9 for subjects in group C+D. Among them, the significant odds ratios of mental workload predicting health complaints and a positive GHQ were 5.7 and 4.0, respectively. Having no regular exercise also resulted in ORs of greater than 3 for health complaints and a positive GHQ. To cope with the health complaints of workers, mental health support by reducing individual workloads is recommended.

ASC/SIL ratio for cytotechnologists: A survey of its utility in clinical practice

The atypical squamous cell to squamous intraepithelial lesion (ASC/SIL) ratio for cytotechnologists (CTs) may correlate with screening sensitivity in some laboratory settings. Whether this ratio can be applied to other laboratory settings is not known. We conducted a survey of nine cytology laboratories and correlated the ASC/SIL ratio of individual CTs with other laboratory characteristics. The ASC/SIL ratio for individual CTs varied from 0.6 to 4.5 (mean: 1.9, median: 1.5). The ASC/SIL ratio within individual laboratories varied up to 567%; 25/78 (32%) CTs had an ASC/SIL ratio of less than 1.5, though only three of nine laboratories had more than one CT with a ratio this low. Laboratories that used 100% location guided screening (ThinPrep Imaging System) were much less likely to have a CT with a ratio <1.5 (1/20, 5%) than laboratories that never used location guided screening (14/34, 42%; P = 0.004). In addition, the normalized variance of these same laboratories that used location guided screening was significantly lower than those that did not (normalized standard deviation 0.32 vs. 0.55, P = 0.004). The ASC/SIL ratios did not correlate with laboratory volume, individual workload, or type of specimen preparation (conventional vs. liquid based). The ASC/SIL ratio for CTs varies widely between and within laboratories, and may correlate with the use of location guided screening. Very low ASC/SIL ratios are unusual, and CTs with low ratios may warrant further evaluation.

Do the RCPath-published workload guidelines underestimate the work rate achievable in subspecialty practice in cellular pathology?

The current Royal College of Pathologists (RCPath) workload guidelines1 represent a big step forward in assessing pathologist workload in cellular pathology by reflecting individual specimen complexity rather than crude specimen...

Comparison between artificial neural network and multilinear regression models in an evaluation of cognitive workload in a flight simulator

In this study, the performances of artificial neural network (ANN) analysis and multilinear regression (MLR) model-based estimation of heart rate were compared in an evaluation of individual cognitive workload. The data comprised electrocardiography (ECG) measurements and an evaluation of cognitive load that induces psychophysiological stress (PPS), collected from 14 interceptor fighter pilots during complex simulated F/A-18 Hornet air battles. In our data, the mean absolute error of the ANN estimate was 11.4 as a visual analog scale score, being 13–23% better than the mean absolute error of the MLR model in the estimation of cognitive workload.

Emergency service systems: The use of the hypercube queueing model in the solution of probabilistic location problems

AbstractProbabilistic location problems are surveyed from the perspective of their use in the design of emergency service systems, with special emphasis on emergency medical systems. Pioneering probabilistic models were defined in the 1980s, as a natural extension of deterministic covering models (first generation models) and backup models (second generation). These probabilistic models, however, adopted simplifying assumptions that in many cases do not correspond to real‐world situations, where servers usually cooperate and have specific individual workloads. Thus the idea of embedding the hypercube queueing model into these formulations is to make them more adherent to the real world. The hypercube model and its extensions are initially presented in some detail, which is followed by a brief review of exact and approximate methods for its solution. Probabilistic models for the design of emergency service systems are then reviewed. The pioneering models of Daskin and ReVelle and Hogan are extended by embedding the hypercube model into them. Solution methods for these models are surveyed next, with comments on specialized models for the design of emergency medical systems for urban areas and highways.